ConnectiCare Prior Authorization Requirements (Commercial)

This list applies to ConnectiCare’s members with commercial benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the Revision History sections and the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Prior Authorization Requirements (Marketplace 2026)

This list applies to ConnectiCare’s members with Marketplace benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Prior Authorization Requirements (Medicare 2026)

To find prior authorization requirements for specific codes, use the Prior Authorization LookUp Tool.

Medicare Prior Authorization Guide

This list applies to ConnectiCare’s members with Medicare benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Prior Authorization Requirements (Medicare 2025)

This list applies to ConnectiCare’s members with Medicare benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

Medical and Radiation Oncology

To find prior authorization requirements for specific codes, use the 

Prior Authorization LookUp Tool.

Use this list to see the medical and radiation oncology procedure, drug, and diagnosis codes that require prior authorization for Marketplace and Medicare members.

To find prior authorization requirements for specific codes, use the 

Prior Authorization LookUp Tool.

Use this list to see the elective diagnostic and interventional cardiovascular services codes that require prior authorization for Medicare members 18 years of age and older beginning July 1, 2026.

ConnectiCare Pharmacy Preauthorization List - through 12/31/2025

Use this list to see the drugs that are associated with the member’s medical benefit.

Drug Preauthorization List

Use this list to see drugs that must meet clinical criteria in order to be covered under the Commercial member’s medical or pharmacy benefit.

Home Infusion Therapy Drug Preauthorization List - Through 12/31/2025

Use this list to see the home infusion therapy drugs that require prior authorization